endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg201625-17endoserg-8177Research ArticleКлиническая лекцияClinical lectureИнтраоперационный нейромониторинг при оперативных вмешательствах на щитовидной и околощитовидных железах: показания к проведению, методика выполненияIntraoperative neuromonitoring in thyroid and parathyroid surgery: indications and methodМакарьинВиктор АлексеевичMakarinViktor A.

к.м.н., хирург-эндокринолог

MD, PhD

info@vmakarin.ruУспенскаяАнна АлексеевнаUspenskayaAnna A.

хирург-эндокринолог

MD

info@vmakarin.ruАлексеевМихаил АлександровичAlekseevMihail A.

врач-анестезиолог

MD

info@vmakarin.ruГорскаяНаталья АлександровнаGorskayaNatal'ja A.

хирург

MD

info@vmakarin.ruСлепцовИлья ВалерьевичSlepstovIl'ja V.

д.м.н., заместитель директора по медицинской части

MD

info@vmakarin.ruЧерниковРоман АнатольевичChernikovRoman A.

к.м.н., заведующий отделением эндокринной хирургии

MD, PhD

info@vmakarin.ruФедотовЮрий НиколаевичFedotovJurij N.

д.м.н., директор

MD, PhD

info@vmakarin.ruТимофееваНаталья ИгоревнаTimofeevaNatal'ja I.

к.м.н., хирург-эндокринолог

MD, PhD

info@vmakarin.ruСеменовАрсений АндреевичSemenovArsenij A.

к.м.н., хирург-эндокринолог

MD, PhD

info@vmakarin.ruМалюговЮрий НиколаевичMalugovJurij N.

хирург-эндокринолог

MD

info@vmakarin.ruБубновАлександр НиколаевичBubnovAleksandr N.

д.м.н., профессор, директор

MD, PhD, professor

info@vmakarin.ruФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава РоссииРоссияUniversity hospital of Saint-Petersburg State UniversityRussian FederationФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава РоссииРоссияUniversity hospital of Saint-Petersburg State UniversityRussian FederationФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава России; ФГБОУ ВО “Санкт-Петербургский государственный университет”РоссияUniversity hospital of Saint-Petersburg State University; Saint-Petersburg State UniversityRussian FederationФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава России; ФГБОУ ВО “Северо-Западный государственный медицинский университет им. И.И. Мечникова” Минздрава РоссииРоссияUniversity hospital of Saint-Petersburg State University; Northern-Western State Mechnikov Medical UniversityRussian FederationФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава РоссииРоссияUniversity hospital of Saint-Petersburg State University; Saint-Petersburg State UniversityRussian FederationФГБУ “Санкт-Петербургский многопрофильный центр” Минздрава России; ФГБОУ ВО Северо-Западный государственный медицинский университет им. И.И. Мечникова Минздрава России; ФГБОУ ВО Санкт-Петербургский государственный университетРоссияUniversity hospital of Saint-Petersburg State University; Northern-Western State Mechnikov Medical University; Saint-Petersburg State UniversityRussian Federation201631102016102Том 10, №2(2016)517Copyright © Макарьин В.А., Успенская А.А., Алексеев М.А., Горская Н.А., Слепцов И.В., Черников Р.А., Федотов Ю.Н., Тимофеева Н.И., Семенов А.А., Малюгов Ю.Н., Бубнов А.Н., 20162016Макарьин В.А., Успенская А.А., Алексеев М.А., Горская Н.А., Слепцов И.В., Черников Р.А., Федотов Ю.Н., Тимофеева Н.И., Семенов А.А., Малюгов Ю.Н., Бубнов А.Н.Makarin V.A., Uspenskaya A.A., Alekseev M.A., Gorskaya N.A., Slepstov I.V., Chernikov R.A., Fedotov J.N., Timofeeva N.I., Semenov A.A., Malugov J.N., Bubnov A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/8177

Интраоперационный нейромониторинг находит все более широкое применение при оперативных вмешательствах на щитовидной и околощитовидных железах как метод, позволяющий уменьшить количество повреждений гортанных нервов при хирургических вмешательствах. В настоящее время с помощью постоянного мониторинга возможно интраоперационно в режиме реального времени оценивать сохранность функции гортанных нервов. В статье, основываясь на опыте выполнения в клинике 1065 оперативных вмешательств с использованием нейромониторинга, мы подробно описываем методику выполнения интраоперационного нейромониторинга гортанных нервов: от особенностей анестезиологического пособия и постановки эндотрахеальной трубки до алгоритма поиска неисправности при потере электромиографического сигнала. Кроме того, в ней также даны объяснения электромиографических показателей, таких как амплитуда сигнала, латентность, порог, LOS (потеря сигнала), и приведены основные источники литературы, посвященные данной проблеме. 

Intraoperative neuromonitoring finds widespread application in thyroid and parathyroid surgery, as a preventive method against laryngeal nerves injuries. Today it is possible to monitor the laryngeal nerve function in real time during an operation. In this article based on experience of 1065 thyroid and parathyroid operations with intraoperative neuromonitoring, we describe in details the procedure of intraoperative neuromonitoring of laryngeal nerves: features of anaesthesia, endotracheal tube position, algorythm of trouble shooting in case of loss of electromyographical sygnal. Besides that, there is an explanation of electromyographical indices, such as: signal amplitude, latency, threshold, LOS (loss of signal); there are main literature sources on this problem.

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The authors declare that there are no conflicts of interest present.